Vulvar, Vaginal, And Cervical Pathology

Front 1

Week 4-What forms the epithelium and stroma of the ovary (hint: embryogenesis)

Back 1

Germ cells migrate to urogenital ridge which induces proliferation of the mesoderm epithelium

Front 2

Week 6-What forms through invagination and fusion of coelomic lining epithelium?

Back 2

lateral Mullerian ducts

Front 3

Upper unfused portions of the mullerian ducts form what?

Back 3

Fallopian tubes

Front 4

Lower fused portions become what? (hint: 3)

Back 4

Uterus, cervix, and upper vagina

Front 5

Urogenital sinus forms what? (hint: 2)

Back 5

lower vagina, vestibule

Front 6

Mesonephric ducts that fail to regress may become what?

Back 6

Gartner duct cysts (also called paratubal or tubal remnant cysts)

Front 7

What is the most frequent cause of human fungal infections?

Back 7

Candida albicans

Front 8

Patients with low neutrophils or T helper 17 cells are prone to infections with what bacterium?

Back 8

Candida albicans

Front 9

Which conditions predispose a pt to Vaginal candidiasis?

Back 9

Pregnancy (or OCP usage)

Antibiotics

Immunosuppressed (cancer, HIV, transplant pts)

Diabetes mellitus

Burn patients

Indwelling Catheter

Front 10

Pt present with intense vulvovaginal pruritis, erythema, & swelling. Says she has a thick white discharge described as "cottage-cheese-like." what test would you order?

Back 10

PAP smear, KOH test

Front 11

What findings on KOH test would be + for candidiasis?

Back 11

Pseudohyphae, fungal organisms, yeast forms

Front 12

Pt presents w/ fever, malaise, tender inguinal nodes. Pelvic pain. Purulent discharge. Dysuria. DDx?

Back 12

Genital HSV (probably T2). (Fun fact: only 1/3 females symptomatic but ALL males are symptomatic)

Front 13

Immunocompetent patients have HSV recurrence d/t:

Back 13

stress, trauma, hormones, temperature changes, UV radiation, etc.

Front 14

Immunocompromised patients have HSV recurrence (more commonly) d/t:

Back 14

meningitis, hepatitis, pneumonitis

Front 15

What is the worst case scenario w/ HSV?

Back 15

Active primary infection in mother at time of delivery-high mortality rate for infant

Front 16

Large flagellated ovoid protozoan causing frothy yellow vaginal discharge

Back 16

trichomonas vaginalis

Front 17

Pt presents w/ dyspareunia. On exam you see a fiery red vaginal and cervical mucosa (colpitis macularis)-called a strawberry cervix. Dx?

Back 17

trichomonas vaginalis

Front 18

Main cause of bacterial vaginosis? (hint: gram - bacillus)

Back 18

Gardnerella vaginalis

Front 19

What are the clinical and histological findings of gardnerella vaginalis?

Back 19

Thing, green-gray, malodorous (fishy) vaginal discharge. Pap smear with "clue cells" CAN CAUSE PREMATURE DELIVERY

Front 20

Small gram-negative obligate intracellular bacteria (hint: most common bacterial STD in the world)

Back 20

Chlamydia trachomatis

Front 21

Chlamydia infections:

Elementary body-->

Reticulate body-->

Back 21

Elementary body: metabolically inactive

Reticulate body: metabolically active

Front 22

Which form of chlamydia is infectious?

Back 22

Elementary body: infectious form in endosome

Front 23

Which 2 organisms are the major causes of PID?

Back 23

Chlamydia & Gonorrhea

Front 24

How do you test for Chlamydia?

Back 24

Nucleic acid amplification test (NAAT's)

Front 25

Child with rash on trunk, arms, and legs. Claims several of the other kids on the wrestling team also have it. Lesion shows pearly, dome-shaped papules that do not appear to be purulent w/ an umbilicated center. You suspect which virus?

Back 25

Molluscum contagiosum: on histo see molluscum bodies (cytoplasmic viral inclusions)

Front 26

Child comes in with raised papules on genitals, lower abdomen, buttocks, and inner thigh. The papules are not purulent and appear to be umbilicated. What should you consider in your ddx?

Back 26

child abuse--sexually transmitted molluscum contagiosum (MCV-2)

Front 27

Gram - diplococcus (coffee bean shape)

(hint: in males it causes urethral discharge)

Back 27

Neisseria Gonorrhoeae

Front 28

How to diagnose Gonorrhoeae

Back 28

culture or NAAT's.

Front 29

N. Gonorrhoeae can become disseminated with which complement deficiency?

Front 30

Bartholin gland abscess or infection may be the initial presentation of which organism?

Back 30

N. Gonorrhoeae

Front 31

33yo Woman, married, trying to conceive for 6 years. Not previously sexually active, but husband has been sexually active since age 14 with numerous partners. She has had regular pap smears for the past several years and had an ectopic pregnancy 3 years prior. Ddx?

Back 31

Gonorrhoeae. Tubal stricture and scarring most likely causing infertility-irreversible.

Front 32

Lichen sclerosus and squamous hyperplasia are examples of what?

Back 32

Leukoplakia--itchy and scaly

Front 33

57 year old woman. post-menopausal for 5 years. Presents w/ atrophic labia (appear to be agglutinated), & constricted vaginal orifice. Dx?

Back 33

Lichen Sclerosus

Front 34

Histology of lichen sclerosus shows what?

Back 34

Degeneration of the basal cells, hyperkeratosis, sclerosis of superficial dermis, lymphocytic infiltrate in underlying dermis.

Front 35

Women with lichen sclerosus are at risk of developing which cancerous lesion?

Back 35

Squamous cell carcinoma

Front 36

condyloma acuminatum caused by? vs Condyloma latum caused by?

Back 36

CA: HPV

CL: Syphilis

Front 37

45 yo woman presents with white lesion on vulva. Biopsy shows hyperkeratosis and thickened epidermis. What caused it?

Back 37

Chronic rubbing or scratching to relieve pruritis (Squamous cell hyperplasia is Dx)

Front 38

Which types of HPV cause condyloma acuminatum (genital warts)?

Back 38

6 and 11

Front 39

What is koilocytic atypia & what is it associated with?

Back 39

viral cytopathic change characterized by atypical enlarged hyperchromatic nuclei w/ perinuclear halo. HPV.

Front 40

Vulvar glandular neoplasm

Back 40

Extrammary Paget disease

Front 41

Most common type of vulvar cancer? Age group?

Back 41

Squamous cell carcinoma (patients over 60)

Front 42

Most vulvar cancers are HPV related T/F?

Back 42

F. 30% are HPV related (younger pts). 70% non-HPV related (older pts).

Front 43

HPV related vulvar carcinoma shows up in reproductive age patients with which precursor lesion? Which type of HPV?

Back 43

Classic VIN. (formerly carcinoma in situ or Bowen disease)

16.

Front 44

Classic VIN and warty vulvar cancer associated w/ other HPV lesions?

Back 44

Yes. 10-30% have HPV related lesions involving vagina/cervix. Frequently multicentric around vulva.

Front 45

Carcinoma that is exophytic or indurated and ulcerated. Small tightly packed basaloid cells. Foci of central necrosis. Presents in 6th decade.

Back 45

Basaloid carcinoma.

Front 46

Carcinoma that is exophytic, has papillary architecture, prominent koilocytic atypia

Back 46

Warty carcinoma

Front 47

Non HPV related vulvar carcinoma precursor lesion is called what?

Back 47

Differentiated VIN or VIN simplex

Front 48

Vulvar carcinoma that has a high frequency of TP53 mutations

Back 48

Non HPV related vulvar carcinoma

Front 49

Non HPV related carcinoma presents in older patients than HPV related vulvar carcinoma. T/F?

Back 49

T. Non HPV 8th decade. HPV 6th decade.

Front 50

Lichen sclerosus is a risk factor for which type of vulvar carcinoma?

Back 50

Non HPV

Front 51

Pruritic, red, crusted, maplike area on labia

Back 51

Extramammary Paget disease

Front 52

cytokeratin 7 + cells says what?

Back 52

Epithelial tumor (seen in extramammary paget disease)

Front 53

Failure of mullerian duct fusion

Back 53

septate or double vagina

Front 54

submucosal cyst in lateral wall of the vagina. Arise from wolffian (mesonephric) duct rests. Assoc w/ dyspareunia. Consider what?

Back 54

Gartner duct cyst

Front 55

Adenosis (remaining endocervical epithelium in adulthood) related to exposure to what?

Back 55

DES (diethylstilbestrol)

Front 56

Vaginal adenosis can cause what kind of carcinoma?

Back 56

Clear cell adenocarcinoma

Front 57

Greatest risk of vaginal cancer is from?

Back 57

Cancer of vulva or cervix--arises from high risk HPV (16, 18)

(fyi squamous cell carcinoma of the vagina is very rare)

Front 58

Upper 2/3 of the vagina drain to which lymph nodes?

Back 58

Pelvic.-->so you wont see LAD

Front 59

Vulva and distal 1/3 of vagina drains where?

Back 59

Inguinal lymph nodes

Front 60

Child less than 5 with polypoid rounded, bulky masses (grapelike clusters) protruding from vagina. Tumor cells resemble a tennis racket.

Back 60

Embryonal rhabdomyosarcoma (also called sarcoma botryoides)

Front 61

Mature squamous epithelium found on which part of cervix?

Back 61

ectocervix

Front 62

Columnar, mucus-secreting epithelium found on which part of cervix?

Back 62

endocervix

Front 63

Transformation zone

Back 63

Squamocolumnar junction where most pathology occurs--sensitive to HPV

Front 64

glycogenated squamous cells that are shed are food for lactobacilli. This makes the vagina acidic (pH 4.5) T/F?

Back 64

True.

Front 65

What is the purpose of an acidic vaginal environment?

Back 65

Suppress growth of other bacteria & candida. Produce H202 which is bacteriotoxic.

Front 66

Bleeding, Intercourse, Douching, and Antibiotics make a pt more resistant to candida and other forms of vaginosis. T/F

Back 66

F. D/t an increase in pH that alters the normal flora and production of H2O2

Front 67

Endocervical polyps are a common cause of what?

Back 67

Bleeding or spotting between periods

Front 68

HPVs are DNA or RNA viruses?

Back 68

DNA

Front 69

Most common type(s) of HPV in cervical cancer?

Back 69

16 (60%)

18 (10%)

Front 70

90% of HPV infections cleared by 24 months. However persistent infections can occur. Major risk?

Back 70

Chronic infection increases risk of cancer dramatically

Front 71

HPVs affect which kinds of cells?

Back 71

Immature basal cells in transformation zone. (can't effect mature cells)

Front 72

Oncogenic activity of HPV is due to which proteins?

Back 72

E6 & E7 (reason for prolonged infection)

E6: inhibits p53.

E7: inhibits p21 and RB-E2F (CAUSES INCREASED CDK4/Cyclin D-->marker for pathologists).

Front 73

What is the purpose of the upregulation of the cyclin-dependent kinase inhibitor p16?

Back 73

Characterizes high-risk HPV

Front 74

HSIL at risk of developing into?

Back 74

Squamous cell carcinoma

Front 75

Koilocytic change/atypia due to?

Back 75

HPV-->viral protein E5 in ER produces the "halo"

Front 76

Diagnosis of SIL is made by:

Back 76

Nuclear enlargement

Variation in nuclear size/shape

Hyperchromasia

Course Chromatin granules

Front 77

CIN classification:

Lower 1/3

Upper 2/3

Back 77

L1/3: LGSIL (CIN 1)

U2/3: HGSIL (CIN 2-3)

Front 78

CIN 3 designated by?

Back 78

full thickness hyperplasia

Front 79

Proliferation marker usually restricted to basal layer in CIN but E6/E7 prevent cell cycle arrest so seen in upper levels

Back 79

Ki-67

Front 80

What are the worst types of cervical carcinoma?

Back 80

Mixed adenosquamous or neuroendocrine--bad prognosis

Front 81

Average age of cervical carcinoma in US is?

Back 81

45

Front 82

Stage 0

Back 82

CIS

Front 83

Stage 1

Back 83

Carcinoma in cervix

Front 84

Stage 2

Back 84

Carcinoma outside of cervix into vagina but not lower 1/3. Not yet to pelvic wall.

Front 85

Stage 3

Back 85

Carcinoma extended to pelvic wall. No cancer-free space between tumor and pelvic wall. Lower 1/3 of vagina now involved.

Front 86

Stage 4

Back 86

Carcinoma beyond true pelvis or involved the mucosa of the bladder or rectum.

Front 87

Cervical cancer mets

Back 87

Lung, liver, bone-->can be initial presentation

Front 88

Death from cervical cancer most often d/t?

Back 88

Local tumor invasion rather than distant mets

Front 89

Treatment of LSIL

Back 89

None. Watch to see if progression occurs.